الفهرس 
? Beta-lactam AntibioticsOnly 14 pages are availabe for public view
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Abstract
E
nterobacteriaceae are the source of community and hospital acquired infections. They have the propensity to spread easily between humans (hand carriage, contaminated food and water) and to acquire genetic material through horizontal gene transfer, mediated mostly by plasmids and transposons. The growing increase in the rates of antibiotic resistance is a major cause for concern in Enterobacteriaceae family.
Practical phenotypic screening and confirmatory tests are needed to facilitate the timely detection of such strains by clinical microbiology laboratories. Adequate detection of carbapenemase-producing microorganisms in the routine diagnostic laboratory is essential for patient care because (i) it is vital for the correct choice of antibiotic therapy and (ii) appropriate hospital hygiene precautions are indicated for patients harboring carbapenemase-producing microorganisms as these strains are associated with multiresistance and epidemics that result in reduced patient safety and increased costs.
Using the broth microdilution method or E-test strips to confirm resistance is more accurate than the antibiotic susceptibility test by disc diffusion, and is essential before reporting resistance to decrease the abuse of other antibiotics which are very limited in this instance and most of them are unavailable in the Egyptian market.
Carbapenemase detection set is a synergestic test which provides a simple, easy, rapid, practical phenotypic method for confirmation of carbapenemase producing Enterobacteriaceae and classification of their classes. Temocillin disk is a good positive test (PPV was 91.6%) for detection of class D carbapenemases.
So, we recommend the following:
Applying carbapenemase detection set in our microbiological laboratory for:
1. Confirmation of resistance in carbapenemase producing Entero-bacteriaceae isolates.
2. Use of temocillin disk as a routine test for identification of Amber class D (OXA 48) CPE.
3. Classification of these classes to describe the appropriate antibiotic for each one e.g temocillin, piperacillin and tazobactam in combination for class D and avibactam for class A.
4. Using it as a rapid screening method in suspicious specimens (where disk diffusion method in not conclusive).
Screening all patients and contacts: case-finding and isolation immediately, to prevent the wider spread of these resistant strains.
All acute care facilities should review microbiology records for the preceding 6-12 months to ensure that previously unrecognized CRE cases have not occurred.
Active surveillance with rapid feedback to identify undetected carriers of carbapenem-resistant or carbapenemase-producing Klebsiella spp. and E. coli. Patients identified as positive by this surveillance testing should be treated as colonized.
Strict adherence to antibiotic policy.